Live music in the intensive care unit-A mixed-methods pilot study exploring the experience and impact of live music played for the adult intensive care patient.

BACKGROUND: Evidence for music's beneficial effect on physical and mental disorders is mounting. Intensive care unit (ICU) patients experience multiple uncomfortable symptoms, which may be alleviated using a music-based intervention. Few studies have examined the experience and the physical impact of patient-tailored live music offered by trained health musicians in an adult ICU. AIMS: This study aimed to explore the experience of live music in adult patients admitted to an ICU, focusing on its effects on relaxation, stress, and pain. STUDY DESIGN: A pilot study with a convergent mixed-methods design. A total of 27 intensive care patients at a Danish University Hospital were offered patient-tailored live music by trained musicians in a single-session design. We performed participant observation and conducted patient interviews using an observational and semistructured interview guide. These data were supported by quantitative pre-post measurements of heart rate, respiration rate, mean arterial blood pressure, subjective pain experience, and heart-rate variability. The study was conducted from February 2020 to December 2021. FINDINGS: Using a Ricoeur-inspired analysis of observations and interviews, we elicited four themes: 'A break where you can swim away and relax', 'The living presence makes the play unique', 'Happy memories of the past and longing for home', and 'An intense and meaningful experience'. The quantitative analysis showed a significant decrease in heart rate (4.33 bpm, p < 0.02), respiration rate (2.93, p < 0.001), and blood pressure (3.30, p < 0.05) and a significant increase in heart-rate variation (-0.22, p < 0.01). Seven patients reported pain reduction after the music intervention, corresponding to a 24% reduction. CONCLUSION: Live music contributes to meaningful moments by bringing elements of everyday life into the ICU and may promote relaxation and reduce stress and pain. RELEVANCE TO CLINICAL PRACTICE: Our findings indicate that live music is a nonpharmacological experience that creates meaningful moments for critically ill patients.

Delirium and delirium severity screening in the intensive care-correspondence of screenings tools.

BACKGROUND: Delirium severity scores are gaining acceptance for measuring delirium in the intensive care unit (ICU). OBJECTIVE: The aim of this study was to evaluate the concordance between the Confusion Assessment Method for the intensive care unit (CAM-ICU)-7 and the Intensive Care Delirium Screening Checklist (ICDSC) as delirium severity measurement tools. METHODS: This was a prospective, comparative, observational multicentre study. This study was conducted in 18 Danish ICUs. Delirium was assessed in adult critically ill patients admitted to an ICU with a Richmond Agitation and Sedation Score (RASS) of -2 or above. ICU nurses assessed delirium with randomised paired delirium screening instruments, using the CAM-ICU, the ICDSC, and the CAM-ICU-7. The correlation between the CAM-ICU-7 and the ICDSC severity scores was evaluated for all predefined patient subgroups. RESULTS: A total of 1126 paired screenings were conducted by 127 ICU nurses in 850 patients. The patients' median age was 70 years (interquartile range: 61-77), 40% (339/850) were female, and 54% (457/850) had at least one positive delirium score. Delirium severity ranges (CAM-ICU-7: 0-7; and ICDSC: 0-8) were positively correlated (Pearson's correlation coefficient, r = 0.83; p < 0.0001). The overall agreement between the CAM-ICU-7 and the ICDSC for delirium measurement (CAM-ICU-7: >2, and ICDSC: >3) was substantial (kappa = 0.74), but the agreement decreased to fair (kappa = 0.38) if a patient had a RASS less than 0. CONCLUSIONS: The agreement between the CAM-ICU-7 and the ICDSC for delirium severity measurement was substantial but might be affected by the patient's sedation and agitation level at the time of assessment. IMPLICATIONS FOR PRACTICE: Both CAM-ICU-7 and ICDSC can be implemented for delirium severity measurement. Attention is warranted in both scores if a patient has a RASS of -2.

Intensive care unit nurses' perception of three different methods for delirium screening: A survey (DELIS-3).

BACKGROUND: Delirium is common in critically ill patients with detrimental effects in terms of increased morbidity, mortality, costs, and human suffering. Delirium detection and management depends on systematic screening for delirium, which can be challenging to implement in clinical practice. OBJECTIVES: The aim of this study was to explore how nurses in the intensive care unit perceived the use of Confusion Assessment Method for the Intensive Care Unit (CAM-ICU), the Confusion Assessment Method for the Intensive Care Unit-7 (CAM-ICU-7), and Intensive Care Delirium Screening Checklist (ICDSC) for delirium screening of patients in the intensive care unit. METHODS: This was a cross-sectional, electronic-based survey of nurses' perceptions of delirium screening with the three different instruments for delirium screening. Nurses were asked to grade their perception of the usability of the three instruments and how well they were perceived to detect delirium and delirium symptom changes on a 1- to 6-point Likert scale. Open questions about perceived advantages and disadvantages of each instrument were analysed using the framework method. RESULTS: One hundred twenty-seven of 167 invited nurses completed the survey and rated the CAM-ICU-7 as faster and easier than the ICDSC, which was more nuanced and reflected changes in the patient's delirium better. Despite being rated as the fastest, easiest, and most used, the CAM-ICU provided less information and was considered inferior to the CAM-ICU-7 and ICDSC. Using familiar instruments made delirium screening easier, but being able to grade and nuance the delirium assessment was experienced as important for clinical practice. CONCLUSIONS: Both the ICDSC and the CAM-ICU-7 were perceived well suited for detection of delirium and reflected changes in delirium intensity. The CAM-ICU was rated as fast and easy but inferior in its ability to grade and nuance the assessment of delirium. Emphasis on clinical meaningfulness and continued education in delirium screening are necessary for adherence to delirium management guidelines.

Does rocking motion calm delirious patients in ICU? A multicentre randomised clinical trial protocol (RockingICU).

BACKGROUND: Rocking chair therapy has been explored in patients with dementia to promote the feeling of relaxation, but not in Intensive Care Unit (ICU) patients with delirium. AIM: The aim is to investigate the effect of a chair with or without rocking motion on the duration of delirium and intensity of agitation in critically ill patients admitted to the ICU. DESIGN: This is an investigator-initiated pragmatic, multicentre, parallel-grouped, centrally randomised, stratified, data analyst-blinded trial. METHOD: We will include patients for 1:1 web-based randomisation, stratified by site in patients 18 y or older with a positive delirium score identified by a validated tool. We will exclude patients mainly due to mobilisation restrictions, body weight exceeding 130 kg, inability to provide consent, and presence of multiresistant bacteria or viral droplet infections. The intervention group will receive a minimum of 20 min of rocking therapy daily. The control group will be transferred to the same type of chair but without rocking therapy daily. A power calculation with a risk reduction of 20%, a power of 80% with an alpha cut-off on 5% and further 20% inclusion gives 76 patients in intervention and control group reaching a total of n = 152 inclusion in the trial. CONCLUSION: The RockingICU trial will provide important new knowledge and raise research questions regarding nonpharmacological interventions to alleviate delirium in ICU patients.

Live music in the intensive care unit - a beautiful experience.

BACKGROUND: The growing number of lightly or non-sedated patients who are critically ill means that more patients experience the noisy and stressful environment. Live music may create positive and meaningful moments. PURPOSE: To explore non-sedated patients' experiences of patient-tailored live music interventions in the intensive care unit. DESIGN: A qualitative study using a phenomenological-hermeneutic approach. Data were collected at two intensive care units from September 2019 to February 2020 exploring 18 live music interventions performed by music students from The Royal Academy of Music, Aarhus, Denmark. METHODS: Observations of live music interventions followed by patient interviews. All data together were analysed using Ricoeur's theory of interpretation. The Consolidated Criteria for Reporting Qualitative Research (COREQ) checklist was used. RESULTS: Five themes emerged: 1) A break from everyday life, 2) A room with beautiful sounds and emotions, 3) Too tired to participate, 4) Knowing the music makes it meaningful and 5) A calm and beautiful moment. CONCLUSION: Patient-tailored live music to awake patients is both feasible and acceptable and perceived as a break from every-day life in the ICU. IMPLICATIONS FOR PRACTICE: Supporting health and well-being by bringing a humanizing resource into the intensive care setting for patients and nurses to enjoy.